Year in Review: Tech focus pivots

The federal government's interoperability regulations have been the talk of healthcare’s technology sector for years—perhaps the only thing that could have eclipsed them was a worldwide pandemic.

2020 kicked off with CMS and the Office of the National Coordinator for Health Information Technology releasing their long-awaited rules on interoperability, application programming interfaces and information-blocking, mandates that industry watchers have been waiting on since the 21st Century Cures Act of 2016.

But the pandemic caused the industry to quickly shift gears. Hospitals across the country spent the early spring building up their telehealth infrastructure, with resources stretched thin to accommodate needs like buying video equipment and other technologies designed to connect people from afar, training staff on how to conduct virtual visits and establishing processes that don’t compromise cybersecurity.

In April, 43.5% of Medicare primary-care visits were provided through telehealth, compared to just 0.1% in February, before the public health emergency. Telehealth spending could grow to $250 billion a year as COVID-19 paves the way for virtual care, according to a report from McKinsey & Co., which determined about 20% of all office, outpatient and home health expenses across Medicare, Medicaid and commercially insured populations could be converted to virtual care.

The pandemic has showcased both the benefits and shortfalls of telehealth this year, providing an avenue for millions of patients to continue to receive care amid stay-at-home orders while also highlighting the so-called “digital divide,” as patients without access to reliable high-speed internet or devices with video capabilities often had to rely on audio-only telephone calls. And rapid adoption of telehealth hasn’t been enough to quell the concerns of some quality analysts. Meantime, providers are watching what telehealth regulatory waivers and reimbursement boosts added during the pandemic remain after it’s over.

Still, companies are betting on sustained interest in telehealth. Amwell in September went public with a $100 million investment from Google, and Teladoc Health in October closed an $18.5 billion merger with Livongo. SOC Telemed, a telehealth company, in November went public through a combination with a special-purpose acquisition company.

Telehealth use soared in the early days of COVID-19, and even as virtual visits have begun to drop—by some estimates, telehealth accounted for 14% visits in April, but shrunk to roughly 6%-7% in the summer and fall—it’s plateaued at a notably higher rate than before the pandemic. That’s a change many insiders are betting will stick around, with hospitals adding telehealth leadership roles and telehealth companies scooping up record levels of investment.

After years in the making, two long-awaited data-sharing regulations from HHS agencies were derailed by COVID-19.

March 9: CMS and HHS’ Office of the National Coordinator for Health Information Technology release final versions of companion interoperability and information-blocking regulations they proposed last year. 

April 21: CMS and ONC delay enforcement of the proposals. ONC sets a new compliance date of Nov. 2 and gives vendors an additional three months of enforcement discretion after that to comply with its health IT certification program; CMS gives insurers an additional six months—until July 2021—to comply with provisions related to application programming interfaces.

Oct. 29: ONC issues an interim final rule pushing back compliance deadlines for health IT certification requirements and information-blocking provisions. Providers won’t be required to come into compliance with information-blocking provisions and vendors won’t have to comply with API certification requirements until April 2021, among other changes.